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Sökücü SN, Satıcı C, Tokgöz Akyıl F, Veske NŞ, Koçal FE, Tural Önür S, Özdemir C. The impact of deep venous thrombosis on 90 day mortality in chronic obstructive pulmonary disease patients presenting with pulmonary embolism. Respir Med Res 2024; 85:101090. [PMID: 38657301 DOI: 10.1016/j.resmer.2024.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND There are a limited number of studies investigating the effect of deep venous thrombosis (DVT) in patients presenting with both pulmonary embolism and chronic obstructive pulmonary disease. The aim of this study is to investigate the prevalence and prognostic significance of DVT in patients with PE-COPD. METHODS COPD patients admitted with a diagnosis of PE to our tertiary hospital between January 2016 and January 2021 were retrospectively evaluated with an electronic hospital database. Univariate and multivariate Cox regression analyses were performed to reveal independent prognostic factors. RESULTS Two hundred thirty-three patients (mean age 65.1 ± 12.2, 158 men (67.5 %)) were included. DVT was present at the time of diagnosis in 45 (19.31 %) of the patients. Patients with DVT tend to have more comorbidities, central pulmonary embolism, higher CRP and d-dimer levels, and SPESI score (p<0.05). After performing multivariate analyses, the presence of DVT (HR=3.48, CI: 1.02- 11.88, p = 0.046), ischemic heart disease (HR=3.82, CI: 1.38- 10.80, p = 0.01), and malignancy (HR=4.85, CI: 1.53- 15.41, p = 0.007) were found to be independent factors in predicting 90-day mortality. CONCLUSIONS In PE-COPD patients, co-existing DVT may predict a worse outcome.
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Affiliation(s)
- Sinem Nedime Sökücü
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Chest Disease, Turkey
| | - Celal Satıcı
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Chest Disease, Turkey
| | - Fatma Tokgöz Akyıl
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Chest Disease, Turkey
| | - Nurdan Şimşek Veske
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Chest Disease, Turkey.
| | - Fatma Elif Koçal
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Chest Disease, Turkey
| | - Seda Tural Önür
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Chest Disease, Turkey
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Figueira‐Gonçalves JM, García-Bello MÁ, Ramallo‐Fariña Y, Méndez R, Latorre Campos A, González-Jiménez P, Peces-Barba G, Molina-Molina M, España PP, García E, Domínguez-Pazos SDJ, García Clemente M, Panadero C, de la Rosa-Carrillo D, Sibila O, Martínez-Pitarch MD, Toledo-Pons N, López-Ramirez C, Almonte-Batista W, Macías-Paredes A, Badenes-Bonet D, Pérez-Rodas EN, Lázaro J, Quirós Fernández S, Cordovilla R, Cano-Pumarega I, Torres A, Menendez R. Persistent Respiratory Failure and Re-Admission in Patients with Chronic Obstructive Pulmonary Disease Following Hospitalization for COVID-19. Int J Chron Obstruct Pulmon Dis 2023; 18:2473-2481. [PMID: 37955022 PMCID: PMC10638925 DOI: 10.2147/copd.s428316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) has been associated with worse clinical evolution/survival during a hospitalization for SARS-CoV2 (COVID-19). The objective of this study was to learn the situation of these patients at discharge as well as the risk of re-admission/mortality in the following 12 months. Methods We carried out a subanalysis of the RECOVID registry. A multicenter, observational study that retrospectively collected data on severe acute COVID-19 episodes and follow-up visits for up to a year in survivors. The data collection protocol includes general demographic data, smoking, comorbidities, pharmacological treatment, infection severity, complications during hospitalization and required treatment. At discharge, resting oxygen saturation (SpO2), dyspnea according to the mMRC (modified Medical Research Council) scale and long-term oxygen therapy prescription were recorded. The follow-up database included the clinical management visits at 6 and 12 months, where re-admission and mortality were recorded. Results A total of 2047 patients were included (5.6% had a COPD diagnosis). At discharge, patients with COPD had greater dyspnea and a greater need for prescription home oxygen. After adjusting for age, sex and Charlson comorbidity index, patients with COPD had a greater risk of hospital re-admission due to respiratory causes (HR 2.57 [1.35-4.89], p = 0.004), with no significant differences in survival. Conclusion Patients with COPD who overcome a serious SARS-CoV2 infection show a worse clinical situation at discharge and a greater risk of re-admission for respiratory causes.
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Affiliation(s)
- Juan Marco Figueira‐Gonçalves
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Miguel Ángel García-Bello
- Evaluation Unit (SESCS), Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo‐Fariña
- Evaluation Unit (SESCS), Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Raúl Méndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Respiratory InFections, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Medicine Department, University of Valencia, Valencia, Spain
| | - Ana Latorre Campos
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Respiratory InFections, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Paula González-Jiménez
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Respiratory InFections, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
- Medicine Department, University of Valencia, Valencia, Spain
| | | | - María Molina-Molina
- ILD Unit, Respiratory Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
| | | | - Estela García
- Respiratory Service, Hospital de Cabueñes, Gijón, Spain
| | | | | | | | | | - Oriol Sibila
- Respiratory Service, Hospital Clínic, Barcelona, Spain
| | | | | | - Cecilia López-Ramirez
- Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del Rocío, Sevilla, Spain
| | | | | | | | | | - Javier Lázaro
- Respiratory Service, Hospital Royo Villanova, Zaragoza, Spain
| | | | - Rosa Cordovilla
- Respiratory Service, Hospital de Salamanca, Salamanca, Spain
| | - Irene Cano-Pumarega
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Respiratory Service, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Antoni Torres
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Respiratory Service, Hospital Clínic, Barcelona, Spain
| | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Respiratory InFections, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Medicine Department, University of Valencia, Valencia, Spain
| | - On behalf of RECOVID
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Respiratory InFections, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Medicine Department, University of Valencia, Valencia, Spain
- Pulmonology Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
- ILD Unit, Respiratory Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
- Respiratory Service, Hospital de Galdakao-Usansolo, Galdakao, Spain
- Respiratory Service, Hospital de Cabueñes, Gijón, Spain
- Respiratory Service, Hospital Universitario de A Coruña, A Coruña, Spain
- Respiratory Service, Hospital Universitario Central de Asturias, Oviedo, Spain
- Respiratory Service, Hospital de Getafe, Getafe, Spain
- Respiratory Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Respiratory Service, Hospital Clínic, Barcelona, Spain
- Respiratory Service, Hospital Lluís Alcanyís, Játiva, Spain
- Respiratory Service, Hospital Son Espases, Palma, Spain
- Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del Rocío, Sevilla, Spain
- Respiratory Service, Hospital de Albacete, Albacete, Spain
- Respiratory Service, Hospital de Sant Jaume, Calella, Spain
- Respiratory Service, Hospital del Mar, Barcelona, Spain
- Respiratory Service, Hospital Municipal de Badalona, Badalona, Spain
- Respiratory Service, Hospital Royo Villanova, Zaragoza, Spain
- Respiratory Service, Hospital Basurto, Bilbao, Spain
- Respiratory Service, Hospital de Salamanca, Salamanca, Spain
- Respiratory Service, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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Xia ZH, Chen WH, Wang Q. Risk factors for venous thromboembolism following surgical treatment of fractures: A systematic review and meta-analysis. Int Wound J 2023; 20:995-1007. [PMID: 36382679 PMCID: PMC10030940 DOI: 10.1111/iwj.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to determine the risk factors for postoperative venous thromboembolism (VTE) in patients treated surgically for fractures using a meta-analytic approach. Electronic searches were performed in PubMed, Embase, and the Cochrane library from inception until February 2022. The odds ratio (OR) and 95% confidence interval (CI) were applied to calculate the pooled effect estimate using the random-effects model. Sensitivity, subgroup, and publication bias tests were also performed. Forty-four studies involving 3 239 291 patients and reporting 11 768 VTE cases were selected for the meta-analysis. We found that elderly (OR: 1.72; 95% CI: 1.38-2.15; P < .001), American Society of Anesthesiologists (ASA) ≥ 3 (OR: 1.82; 95% CI: 1.46-2.29; P < .001), blood transfusion (OR: 1.82; 95% CI: 1.14-2.92; P = .013), cardiovascular disease (CVD) (OR: 1.40; 95% CI: 1.22-1.61; P < .001), elevated D-dimer (OR: 4.55; 95% CI: 2.08-9.98; P < .001), diabetes mellitus (DM) (OR: 1.36; 95% CI: 1.19-1.54; P < .001), hypertension (OR: 1.31; 95% CI: 1.09-1.56; P = .003), immobility (OR: 3.45; 95% CI: 2.23-5.32; P < .001), lung disease (LD) (OR: 2.40; 95% CI: 1.29-4.47; P = .006), obesity (OR: 1.52; 95% CI: 1.27-1.82; P < .001), peripheral artery disease (PAD) (OR: 2.13; 95% CI: 1.21-3.73; P = .008), prior thromboembolic event (PTE) (OR: 5.17; 95% CI: 3.14-8.50; P < .001), and steroid use (OR: 2.37; 95% CI: 1.73-3.24; P < .001) were associated with an increased risk of VTE. Additionally, regional anaesthesia (OR: 0.66; 95% CI: 0.45-0.96; P = .029) was associated with a reduced risk of VTE following surgical treatment of fractures. However, alcohol intake, cancer, current smoking, deep surgical site infection, fusion surgery, heart failure, hypercholesterolemia, liver and kidney disease, sex, open fracture, operative time, preoperative anticoagulant use, rheumatoid arthritis, and stroke were not associated with the risk of VTE. Post-surgical risk factors for VTE include elderly, ASA ≥ 3, blood transfusion, CVD, elevated D-dimer, DM, hypertension, immobility, LD, obesity, PAD, PTE, and steroid use.
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Affiliation(s)
- Zhen-Hua Xia
- Department of Surgery, Shanghai Shidong Hospital, Shanghai, China
| | - Wei-Hua Chen
- Department of Surgery, Shanghai Shidong Hospital, Shanghai, China
| | - Qun Wang
- Department of Surgery, Shanghai Shidong Hospital, Shanghai, China
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Rijal S, Kaur G, Loh CC, Sagireddy S, Dweik H, Makrani MP, Akella R. Risk Factor Analysis of Venous Thromboembolism in Cancer: A National Inpatient Sample Study. Cureus 2022; 14:e24323. [PMID: 35607590 PMCID: PMC9122694 DOI: 10.7759/cureus.24323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 12/03/2022] Open
Abstract
Objective In this study, we aimed to explore the association of demographic characteristics and comorbidities with the risk of venous thromboembolism (VTE) in cancer inpatients, as well as to delineate the mortality risk in cancer inpatients with VTE. Methods We conducted a retrospective cohort analysis based on the National Inpatient Sample (NIS) 2012-2014, involving 339,395 inpatients with a primary diagnosis of cancer subdivided into cohorts without VTE (n=331,695) and with VTE (n=7,700). We used a binomial logistic regression model to evaluate the odds ratio (OR) of demographics, comorbidities, and in-hospital mortality rate with respect to cancer inpatients with VTE. Results A higher proportion of cancer inpatients with VTE were 36-50 years in age (83.1%), male (50%), and of black (19.3%) and Hispanic ethnicity (17.2%) compared to the non-VTE cohort. The prevalence of comorbidities was higher in the VTE cohort, including HIV/AIDS, congestive heart failure (CHF), chronic pulmonary disease, diabetes, hypertension, and obesity. CHF demonstrated the highest risk of association with VTE (OR: 2.68, 95% CI: 2.30-3.12), followed by hypertension (OR: 1.23, 95% CI: 1.16-1.29), diabetes (OR: 1.16, 95% CI: 1.07-1.26), and chronic pulmonary disease (OR: 1.13, 95% CI: 1.05-1.22). Conversely, valvular diseases, obesity, and drug abuse were not significantly associated with VTE in cancer inpatients. The in-hospital mortality rate was higher in cancer inpatients with VTE (12% vs. 2.1%), thereby increasing the in-hospital mortality risk (OR: 3.87, 95% CI: 3.58-4.18). Conclusion VTE risk was significantly higher in cancer patients with comorbid CHF, hypertension, diabetes, and chronic pulmonary disease. The risk of all-cause in-hospital mortality was increased by four times in cancer inpatients with VTE.
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Kristensen A, Sivapalan P, Bagge K, Biering-Sørensen T, Sørensen R, Eklöf J, Jensen JUS. Association between anticoagulant therapy, exacerbations and mortality in a Danish cohort of patients with Chronic Obstructive Pulmonary Disease. Sci Prog 2022; 105:368504221104331. [PMID: 35673760 PMCID: PMC10358626 DOI: 10.1177/00368504221104331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVES Pulmonary Embolism has been frequently reported in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD). The study aimed to determine whether COPD patients who receive anticoagulant (AC) therapy have a reduced risk of hospitalization due to AE-COPD and death. METHODS This nationwide population-based study was based on data from the Danish Register of COPD (DrCOPD), which contains complete data on COPD outpatients between 1st January 2010 and 31st December 2018. National registers were used to obtain information regarding comorbidities and vital status. Propensity-score matching and Cox proportional hazards models were used to assess AE-COPD and death after one year. RESULTS The study cohort consisted of 58,067 patients with COPD. Of these, 5194 patients were on AC therapy. The population was matched 1:1 based on clinical confounders and AC therapy, resulting in two groups of 5180 patients. We found no association between AC therapy and AE-COPD or all-cause mortality in the propensity-score matched population (HR 1.03, 95% CI 0.96-1.10, p = 0.37). These findings were confirmed in a competing risk analysis. In the sensitivity analysis, we performed an adjusted analysis of the complete cohort and found a slightly increased risk of AE-COPD or death in patients treated with AC therapy. This study found a low incidence of pulmonary embolisms and deep venous thrombosis in both groups. CONCLUSIONS AC therapy was not associated with the risk of hospitalization due to AE-COPD or all-cause mortality.
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Affiliation(s)
- A Kristensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - P Sivapalan
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - K Bagge
- Department of Clinical Microbiology, Amager and Hvidovre University Hospital, Copenhagen, Denmark
| | - T Biering-Sørensen
- Department of Internal Medicine, Section of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - R Sørensen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J Eklöf
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - JUS Jensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- PERSIMUNE: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, institution-id-type="Ringgold" />Faculty of Health Sciences, University of Copenhagen, Denmark
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Han W, Wang M, Xie Y, Ruan H, Zhao H, Li J. Prevalence of Pulmonary Embolism and Deep Venous Thromboembolism in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:732855. [PMID: 35355978 PMCID: PMC8959435 DOI: 10.3389/fcvm.2022.732855] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of pulmonary embolism (PE) and deep venous thrombosis (DVT). AECOPD combined with PE and DVT poses challenges for treatment and management. This necessitates prevention and management to estimate the overall prevalence of PE and DVT among patients with AECOPD and to identify the risk factors. Methods We searched the PubMed, Embase, and Cochrane Library databases from their inception to January 9, 2021 and extracted the data from the included studies. The risk of bias was assessed for each study. We separately calculated the prevalence of PE and DVT in patients with AECOPD. Subgroup analysis and meta-regression analyses were performed to determine the sources of heterogeneity. Furthermore, we assessed the publication bias. Results The meta-analysis included 20 studies involving 5,854 people. The overall prevalence of PE and DVT among patients with AECOPD was 11% (95% CI: 0.06–0.17) and 9% (95% CI: 0.06–0.12), respectively. Subgroup analysis demonstrated that the prevalence of PE among patients with AECOPD was 12, 2, 7, and 16% in the European, South-East Asia, Western Pacific, and Eastern Mediterranean regions, respectively, and the DVT was 10, 9, 9, and 4%, respectively. The prevalence of PE among patients with AECOPD aged ≥ 70 and <70 years old was 6 and 15%, respectively, and the DVT was 8 and 9%, respectively. The prevalence of PE among patients with AECOPD diagnosed within 48 h and other times (beyond 48 h or not mentioned) was 16 and 6%, respectively, and DVT was 10 and 7%, respectively. Conclusion The pooled prevalence of PE and DVT among patients with AECOPD was insignificantly different between the different age groups and the WHO regions. However, the early diagnosis was associated with a higher prevalence of PE. Clinicians and the public need to further improve the awareness of prevention and management for PE and DVT among patients with AECOPD. Systematic Review Registration PROSPERO, identifier CRD42021260827.
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Affiliation(s)
- Weihong Han
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Minghang Wang
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yang Xie
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Huanrong Ruan
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Hulei Zhao
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Hulei Zhao
| | - Jiansheng Li
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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Wang P, Wang Y, Yuan Z, Wang F, Wang H, Li Y, Wang C, Li L. Venous thromboembolism risk assessment of surgical patients in Southwest China using real-world data: establishment and evaluation of an improved venous thromboembolism risk model. BMC Med Inform Decis Mak 2022; 22:59. [PMID: 35246122 PMCID: PMC8895056 DOI: 10.1186/s12911-022-01795-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/01/2022] [Indexed: 12/20/2022] Open
Abstract
Background Venous thromboembolism (VTE) risk assessment in surgical patients is important for the appropriate diagnosis and treatment of patients. The commonly used Caprini model is limited by its inadequate ability to discriminate between risk stratums on the surgical population in southwest China and lengthy risk factors. The purpose of this study was to establish an improved VTE risk assessment model that is accurate and simple. Methods This study is based on the clinical data from 81,505 surgical patients hospitalized in the Southwest Hospital of China between January 1, 2019 and June 18, 2021. Among the population, 559 patients developed VTE. An improved VTE risk assessment model, SW-model, was established through Logistic Regression, with comparisons to both Caprini and Random Forest. Results The SW-model incorporated eight risk factors. The area under the curve (AUC) of SW-model (0.807 [0.758, 0.853], 0.804 [0.765, 0.840]), are significantly superior (p = 0.001 and p = 0.044) to those of the Caprini (0.705 [0.652, 0.757], 0.758 [0.719, 0795]) on two test sets, but inferior (p < 0.001 and p = 0.002) to Random Forest (0.854 [0.814, 0.890], 0.839 [0.806, 0.868]). In decision curve analysis, within threshold range from 0.015 to 0.04, the DCA curves of the SW-model are superior to Caprini and two default strategies. Conclusions The SW-model demonstrated a higher discriminative capability to distinguish VTE positive in surgical patients compared with the Caprini model. Compared to Random Forest, Logistic Regression based SW-model provided interpretability which is essential in guarantee the procedure of risk assessment transparent to clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01795-9.
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Affiliation(s)
- Peng Wang
- College of Computer Science, Chongqing University, Chongqing, China.,Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Yao Wang
- Yidu Cloud Technology Inc, Beijing, China
| | - Zhaoying Yuan
- Center for Applied Statistics and School of Statistics, Renmin University of China, Beijing, China
| | - Fei Wang
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Hongqian Wang
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Ying Li
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Chengliang Wang
- College of Computer Science, Chongqing University, Chongqing, China.
| | - Linfeng Li
- Yidu Cloud Technology Inc, Beijing, China.
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Petris OR, Cojocaru E, Fildan AP, Cojocaru C. COPD and Anticoagulation Therapy: Time for a New Approach? Int J Chron Obstruct Pulmon Dis 2021; 16:3429-3436. [PMID: 34955638 PMCID: PMC8694113 DOI: 10.2147/copd.s340129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most challenging chronic disease nowadays due to increased morbidity and mortality, despite the multiple new therapies included in the therapeutic scheme. A possible cause may be insufficient approach to thromboembolic risk in these patients, scientific data being so far insufficient and relatively controversial. Areas covered: anticoagulant therapy is used mainly during severe exacerbations. There are data that have shown that therapy with low weight heparins injectable anticoagulants causes not only a reduction in thromboembolic risk but also an improvement in respiratory function parameters. Expert opinion: a number of COPD phenotypes are more prone to procoagulant status and thrombus formation. A layered approach to COPD patients in terms of antithrombotic prophylaxis is needed. Although current published clinical data have not provided irrefutable evidence, possibly due to the relatively heterogeneous approach to inclusion criteria, the frequent identification of autopsy holes in patients with COPD suggests that the high risk of mortality is due to specific bronchopulmonary changes and pulmonary embolism.
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Affiliation(s)
- Ovidiu Rusalim Petris
- Medical II Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, 700115, Romania
| | - Elena Cojocaru
- Morpho-Functional Sciences II Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, 700115, Romania
| | - Ariadna Petronela Fildan
- Internal Medicine 3rd Department, Faculty of Medicine, Ovidius University of Constanta, Constanta, 900527, Romania
| | - Cristian Cojocaru
- Medical III Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, 700115, Romania
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9
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Basil N, Ekström M, Piitulainen E, Lindberg A, Rönmark E, Jehpsson L, Tanash H. Severe alpha-1-antitrypsin deficiency increases the risk of venous thromboembolism. J Thromb Haemost 2021; 19:1519-1525. [PMID: 33763945 DOI: 10.1111/jth.15302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Severe alpha-1-antitrypsin deficiency (AATD), phenotype PiZZ, is associated with increased risk of liver disease and chronic obstructive pulmonary disease (COPD), but the risk of venous thromboembolism (VTE) is unknown. Our aim was to evaluate the risk of VTE in individuals with severe AATD compared with control subjects from the general population. METHODS Individuals with severe AATD (n = 1577) were recruited from the Swedish national AATD register. Control subjects (n = 5969) were selected from the OLIN (Obstructive Lung Disease in Northern Sweden) studies, that include a random general population sample. Longitudinal data on VTE and diagnoses were obtained from the Swedish National Patient Registry. Associations were analyzed using multivariable Cox regression. RESULTS At inclusion, 46% of the AATD individuals and 53% of the controls were never-smokers. COPD was present in 46% of the AATD individuals compared with 4% of the controls. During a median follow-up of 18 years, 116 (7%) of the AATD individuals and 89 (1%) of the control subjects developed VTE, unadjusted hazard ratio 6.5 (95% confidence interval 4.9-8.6). Risk factors for incident VTE were male gender, age, COPD, cancer, and liver disease. Adjusting for these factors, the AATD individuals had a significantly higher risk of incident VTE, adjusted hazard ratio 4.2 (95% confidence interval 2.9-6.2) as compared with the controls. CONCLUSION Subjects with severe AATD have considerably increased risk of developing VTE compared with the general population, even after accounting for risk factors. This calls for optimized risk factor management and clinical follow-up of this patient group.
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Affiliation(s)
- Nawfal Basil
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Eeva Piitulainen
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anne Lindberg
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Jehpsson
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Hanan Tanash
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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10
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Affiliation(s)
- David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany
| | - Alvar A Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and National Spanish Network for Respiratory Research (CIBERES), Barcelona, Spain.
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11
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Affiliation(s)
- David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany
| | - Alvar A Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and National Spanish Network for Respiratory Research (CIBERES), Barcelona, Spain
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12
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Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA. Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 203:24-36. [PMID: 33146552 PMCID: PMC7781116 DOI: 10.1164/rccm.202009-3533so] [Citation(s) in RCA: 351] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications of their therapy are required. It has raised questions about recognizing and differentiating coronavirus disease (COVID-19) from COPD given the similarity of the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods for literature review to present an overview of the management of patients with COPD during the COVID-19 pandemic. It is unclear whether patients with COPD are at increased risk of becoming infected with SARS-CoV-2. During periods of high community prevalence of COVID-19, spirometry should only be used when it is essential for COPD diagnosis and/or to assess lung function status for interventional procedures or surgery. Patients with COPD should follow basic infection control measures, including social distancing, hand washing, and wearing a mask or face covering. Patients should remain up to date with appropriate vaccinations, particularly annual influenza vaccination. Although data are limited, inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides should continue to be used as indicated for stable COPD management. Systemic steroids and antibiotics should be used in COPD exacerbations according to the usual indications. Differentiating symptoms of COVID-19 infection from chronic underlying symptoms or those of an acute COPD exacerbation may be challenging. If there is suspicion for COVID-19, testing for SARS-CoV-2 should be considered. Patients who developed moderate-to-severe COVID-19, including hospitalization and pneumonia, should be treated with evolving pharmacotherapeutic approaches as appropriate, including remdesivir, dexamethasone, and anticoagulation. Managing acute respiratory failure should include appropriate oxygen supplementation, prone positioning, noninvasive ventilation, and protective lung strategy in patients with COPD and severe acute respiratory distress syndrome. Patients who developed asymptomatic or mild COVID-19 should be followed with the usual COPD protocols. Patients who developed moderate or worse COVID-19 should be monitored more frequently and accurately than the usual patients with COPD, with particular attention to the need for oxygen therapy.
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Affiliation(s)
- David M. G. Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Gerard J. Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alberto Papi
- Department of Medical Sciences, Cardiorespiratory and Internal Medicine Unit, University of Ferrara, Ferrara, Italy
| | - Dave Singh
- Manchester University NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Antonio Anzueto
- Division of Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health, University of Texas, San Antonio, Texas
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - Alvar A. Agusti
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain; and
| | - on behalf of the GOLD Science Committee
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Medical Sciences, Cardiorespiratory and Internal Medicine Unit, University of Ferrara, Ferrara, Italy
- Manchester University NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
- Division of Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health, University of Texas, San Antonio, Texas
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain; and
- Department of Medicine, Pulmonary, and Critical Care Medicine, the German Center for Lung Research, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
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13
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Bhagat S, Biswas I, Ahmed R, Khan GA. Hypoxia induced up-regulation of tissue factor is mediated through extracellular RNA activated Toll-like receptor 3-activated protein 1 signalling. Blood Cells Mol Dis 2020; 84:102459. [PMID: 32559654 PMCID: PMC7287429 DOI: 10.1016/j.bcmd.2020.102459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 12/26/2022]
Abstract
Sterile Inflammation (SI), a condition where damage associated molecular patterns (DAMPs) released from dying cells, leads to TLR (Toll-like receptor) activation and triggers hypoxemia in circulation leading to venous thrombosis (VT) through tissue factor (TF) activation, but its importance under acute hypoxia (AH) remains unexplored. Thus, we hypothesized that eRNA released from dying cells under AH activates TF via the TLR3-ERK1/2-AP1 pathway, leading to VT. Animals were exposed to stimulate hypoxia for 0–24 h at standard temperature and humidity. RNaseA and DNase1 were injected immediately before exposure. TLR3 gene silencing was performed through in vivo injection of TLR3 siRNA. 80 μg/kg BW of isolated eRNA and eDNA were injected 6 h prior to sacrifice. Antigens of TF pathway were determined by ELISA and TF activity by a chromogenic assay. AH exposure significantly induced release of SI markers i.e. eRNA, eDNA, HMGB1 and upregulated TLR3, ERK1/2 (Extracellular signal-regulated kinases), AP1 (Activator Protein-1) and TF, whereas RNaseA pre-treatment diminished the effect of AH, thus inhibiting TF expression as well as activity during AH. Hence, we propose a possible mechanism of AH-induced TF activation and thrombosis where RNaseA can become the novel focal point in ameliorating therapy for AH induced thrombosis. Acute hypoxia exposure leads to systemic Sterile Inflammation. eRNA regulates upregulation of TF by activation of TLR3 pathway. RNase A pre-treatment ameliorates effect of acute hypoxia on coagulation.
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Affiliation(s)
- Saumya Bhagat
- Defence Institute of Physiology and Allied Sciences, Timarpur, Delhi, India
| | - Indranil Biswas
- Defence Institute of Physiology and Allied Sciences, Timarpur, Delhi, India
| | - Rehan Ahmed
- Army Hospital Research and Referral, Delhi, India
| | - Gausal A Khan
- Defence Institute of Physiology and Allied Sciences, Timarpur, Delhi, India; Department of Physiology and Physiotherapy, CMNHS, Fiji National University, Suva, Fiji Islands.
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14
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Børvik T, Evensen LH, Morelli VM, Melbye H, Brækkan SK, Hansen J. Impact of respiratory symptoms and oxygen saturation on the risk of incident venous thromboembolism-the Tromsø study. Res Pract Thromb Haemost 2020; 4:255-262. [PMID: 32110756 PMCID: PMC7040548 DOI: 10.1002/rth2.12299] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with risk of venous thromboembolism (VTE). It remains unknown whether individual respiratory symptoms and lowered oxygen saturation (SpO2), individually and in combination with COPD, affect the risk of VTE. OBJECTIVES To investigate whether measures of respiratory impairments including respiratory symptoms and SpO2, individually and combined with COPD, were associated with an increased risk of VTE. METHODS Spirometry, SpO2, and self-reported respiratory symptoms were collected in 8686 participants from the fifth (2001-2002) and sixth (2007-2008) surveys of the Tromsø Study. Incident VTE events were registered from the date of inclusion to December 31, 2016. Cox regression models with exposures and confounders as time-varying covariates (for repeated measurements) were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE. RESULTS During a median follow-up of 9.1 years, 330 participants developed incident VTE. Subjects with SpO2 ≤ 96% (lowest 20th percentile) had a 1.5-fold higher risk of VTE (adjusted HR, 1.48; 95% CI, 1.13-1.93) compared with those with SpO2 ≥ 98%. Severe respiratory symptoms (dyspnea, cough, and phlegm) were associated with a 1.4- to 2.0-fold higher risk of VTE compared with no such symptoms. COPD, combined with respiratory symptoms or lowered SpO2, had an additive effect on the VTE risk. CONCLUSIONS Lowered SpO2 and severe respiratory symptoms were associated with increased VTE risk. COPD combined with respiratory impairments had an additive effect on VTE risk, and may suggest particular attention on VTE preventive strategies in COPD patients with respiratory impairments.
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Affiliation(s)
- Trond Børvik
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Line H. Evensen
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Vania M. Morelli
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Hasse Melbye
- General Practice Research UnitDepartment of Community MedicineUiT‐The Arctic University of NorwayTromsøNorway
| | - Sigrid K. Brækkan
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - John‐Bjarne Hansen
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
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15
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Abstract
Systemic anticoagulation may be beneficial in pulmonary arterial hypertension, but there is no randomized clinical trial data to guide therapeutic decision making, and current guidelines do not account for patient preferences or quality of life. Decision analytic models to evaluate the potential risks and benefits of systemic anticoagulation in pulmonary arterial hypertension patients, focusing on the benefit in quality-adjusted life years, may be helpful in clarifying this uncertainty. We constructed a 31-state Markov decision analytic model to explore anticoagulation and no anticoagulation strategies. Modeled patient characteristics included gender, use of central catheter-based pulmonary arterial hypertension therapy, type of pulmonary arterial hypertension (idiopathic, idiopathic pulmonary arterial hypertension, or connective-tissue associated, connective tissue disease-pulmonary arterial hypertension), and use of oral contraceptive medication by females. Modeled events included mortality, thromboembolic complications, atrial fibrillation, stroke, and anticoagulation bleeding. Deterministic and probabilistic sensitivity analyses were performed. Anticoagulation was favored in all idiopathic pulmonary arterial hypertension cases, with a gain of 0.43-0.51 quality-adjusted life years, and detrimental in all connective tissue disease-pulmonary arterial hypertension cases, with a loss of 0.66-1.89 quality-adjusted life years. Anticoagulation would need to demonstrate a hazard ratio for pulmonary arterial hypertension mortality of 0.95 or better to be favored. In our model, idiopathic pulmonary arterial hypertension patients benefit from anticoagulation in terms of quality-adjusted life years, and connective tissue disease-pulmonary arterial hypertension patients were harmed, with a hazard ratio for pulmonary arterial hypertension mortality of 0.95 or better being required to favorably impact quality-adjusted life years. These results suggest that anticoagulation significantly improves quality adjusted life years and should be offered to all idiopathic pulmonary arterial hypertension patients. Shared decision models based on these results may help clarify therapeutic decision-making uncertainty in pulmonary arterial hypertension patients.
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Affiliation(s)
- Arun Jose
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mark H Eckman
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean M Elwing
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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16
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Dong W, Zhu Y, Du Y, Ma S. Association between features of COPD and risk of venous thromboembolism. Clin Respir J 2019; 13:499-504. [PMID: 31172658 DOI: 10.1111/crj.13051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/03/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with risk of venous thromboembolism (VTE) events. A detailed understanding of which clinical features of COPD increase risk of VTE events is needed. OBJECTIVES To investigate the association between features of COPD and risk of venous thromboembolism. METHODS A retrospective observational clinical study was conducted on 551 consecutive COPD patients visiting the Department of Respiratory and Critical Care Medicine of Tianjin Chest Hospital between February 2014 and April 2018. Finally, 151 patients were eligible for inclusion. Of these, 29 patients had COPD with VTE and 121 patients had COPD without VTE. Patient informations regarding age, gender, BMI, smoking history, smoking status (package/year), COPD-related symptoms, lung function, number of acute exacerbations and imaging visual emphysema were gathered. RESULTS Among the 29 VTE patients, 18 patients had PE and five had DVT, while 6 patients had simultaneous PE and DVT. There were statistically significant differences in GOLD grade, Imaging visual emphysema, and frequent acute exacerbations between the two groups. Multivariate logistic regression analysis showed that after adjustment for gender, age, BMI and smoking history, there were statistically significant for visible emphysema (OR = 3.54, 95% CI: 1.13-11.08; P = 0.03) and GOLD grade (OR = 1.77, 95% CI: 1.04-3.01; P = 0.035), but not for frequent acute exacerbations (OR = 1.65, 95% CI: 0.62-4.38; P = 0.31). CONCLUSIONS Visual emphysema is an independent risk factor for VTE events and the risk of VTE in COPD patients increases with the degree of airway obstruction. However, there is no evidence of an association between exacerbation frequency and VTE events.
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Affiliation(s)
- Weigang Dong
- Department of respiratory and CriticalCare Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Yaqian Zhu
- Department of respiratory and CriticalCare Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Yan Du
- Department of respiratory and CriticalCare Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Shuping Ma
- Department of respiratory and CriticalCare Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
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17
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Hettiarachchi GK, Katneni UK, Hunt RC, Kames JM, Athey JC, Bar H, Sauna ZE, McGill JR, Ibla JC, Kimchi-Sarfaty C. Translational and transcriptional responses in human primary hepatocytes under hypoxia. Am J Physiol Gastrointest Liver Physiol 2019; 316:G720-G734. [PMID: 30920299 PMCID: PMC6620582 DOI: 10.1152/ajpgi.00331.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The liver is the primary source of a large number of plasma proteins and plays a critical role in multiple biological processes. Inadequate oxygen supply characterizing various clinical settings such as liver transplantation exposes the liver to hypoxic conditions. Studies assessing hypoxia-induced global translational changes in liver are lacking. Here, we employed a recently developed ribosome-profiling technique to assess global translational responses of human primary hepatocytes exposed to acute hypoxic stress (1% O2) for the short term. In parallel, transcriptome profiling was performed to assess mRNA expression changes. We found that translational responses appeared earlier and were predominant over transcriptional responses. A significant decrease in translational efficiency of several ribosome genes indicated translational inhibition of new ribosome protein synthesis in hypoxia. Pathway enrichment analysis highlighted altered translational regulation of MAPK signaling, drug metabolism, oxidative phosphorylation, and nonalcoholic fatty liver disease pathways. Gene Ontology enrichment analysis revealed terms related to translation, metabolism, angiogenesis, apoptosis, and response to stress. Transcriptional induction of genes encoding heat shock proteins was observed within 30 min of hypoxia. Induction of genes encoding stress response mediators, metabolism regulators, and proangiogenic proteins was observed at 240 min. Despite the liver being the primary source of coagulation proteins and the implicated role of hypoxia in thrombosis, limited differences were observed in genes encoding coagulation-associated proteins. Overall, our study demonstrates the predominance of translational regulation over transcription and highlights differentially regulated pathways or biological processes in short-term hypoxic stress responses of human primary hepatocytes. NEW & NOTEWORTHY The novelty of this study lies in applying parallel ribosome- and transcriptome-profiling analyses to human primary hepatocytes in hypoxia. To our knowledge, this is the first study to assess global translational responses using ribosome profiling in hypoxic hepatocytes. Our results demonstrate the predominance of translational responses over transcriptional responses in early hepatic hypoxic stress responses. Furthermore, our study reveals multiple pathways and specific genes showing altered regulation in hypoxic hepatocytes.
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Affiliation(s)
- Gaya K. Hettiarachchi
- 1Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | - Upendra K. Katneni
- 1Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | - Ryan C. Hunt
- 1Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | - Jacob M. Kames
- 1Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | - John C. Athey
- 1Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | - Haim Bar
- 2Department of Statistics, University of Connecticut, Storrs, Connecticut
| | - Zuben E. Sauna
- 1Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | - Joseph R. McGill
- 1Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | - Juan C. Ibla
- 3Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Chava Kimchi-Sarfaty
- 1Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
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18
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Guo M, Lu L, Sun Y, Li L, Wu M, Lang J. Comprehensive functional exercises with patient education for the prevention of venous thrombosis after major gynecologic surgery: A randomized controlled study. Thromb Res 2019; 178:69-74. [PMID: 30991240 DOI: 10.1016/j.thromres.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/09/2019] [Accepted: 04/10/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore the functional exercises of deep breathing and lower limb motions for the prevention of venous thrombosis in patients undergoing major surgery for gynecologic malignancy. METHODS All eligible patients admitted to the gynecologic oncology unit were randomized into the study and control groups. A comprehensive set of functional exercises was provided to the study group under the instruction and supervision of medical staff. All patients received pre- and postoperative educational material, followed by questionnaires about the patient's perception and satisfaction of the material, and all indicated prophylactic medications were administered. RESULTS In total, 132 patients were randomized, and 62 and 53 patients in the study and control groups, respectively, were included in the final analysis. Venous thrombosis, identified by symptoms and/or postoperative ultrasound, was found in 9 (17.0%) and 2 (3.2%) patients in the control and study groups, respectively, which was significantly different (p = 0.012), and most of these instances (9/11, 81.8%) were intramuscular vein thrombosis. The incidence of venous thromboembolism (VTE) was not significantly different (1 [1.9%] versus 1 [1.6%]) between the two groups. In the regression model, functional exercise was the only factor associated with venous thrombosis (odds ratio 0.170, 95% confidence interval 0.035-0.815, p = 0.032) adjusted with diagnosis and surgical parameters. The detailed educational material had improved the perception and satisfaction of patients about the prevention of VTE. CONCLUSION In a phase 3, single-center randomized controlled study, a comprehensive set of functional exercises combining deep breathing and lower limb motions would significantly decrease the risk of venous thrombosis in patients undergoing major surgery for gynecologic malignancy, especially the risk of intravascular thrombosis.
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Affiliation(s)
- Miao Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Ling Lu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
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19
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Pang H, Wang L, Liu J, Wang S, Yang Y, Yang T, Wang C. The prevalence and risk factors of venous thromboembolism in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease. Clin Respir J 2018; 12:2573-2580. [PMID: 30207643 DOI: 10.1111/crj.12959] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/25/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not rare, which would affect the patient's prognosis. OBJECTIVES To examine the prevalence, risk factors and clinical characteristics of AECOPD patients with VTE. METHODS We performed this multi-center, prospective, observational study that involved 16 hospitals in China. Patients admitted to hospital due to AECOPD were consecutively enrolled. Baseline characteristics, VTE risk factors, symptoms, signs and auxiliary examination results were collected. Lower limb venous ultrasound and computed tomography pulmonary angiography were examined. RESULTS Between June 2009 and October 2010, a total of 1144 AECOPD patients (the average age 72.0 ± 9.1 years, 761 males) were enrolled in this study. Seventy-eight (6.8%) were diagnosed with VTE, including 24 PE, 64 DVT, 10 combined PE and DVT. VTE patients were older than non-VTE patients. History of venous thromboembolism and lower extremity varicose vein, and presence of longer immobility (≥3 days), lower limbs problems of swelling, pain and walking difficulties, diuretics use, fever, syncope, higher d-dimer and lower hemoglobin were more common in VTE patients than in non-VTE patients. After adjusting the covariates, venous thrombosis history, prolonged immobility (≥3 days), lower limb pain before hospitalization, higher d-dimer independently associated with VTE development. Regular glucocorticoid use was not associated with increased risk of VTE in this set of patients. CONCLUSION VTE is relatively common among hospitalized AECOPD patients. Conventional prophylactic anticoagulant therapy may be considered for those hospitalized AECOPD patients with risk factors.
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Affiliation(s)
- Hongyan Pang
- Department of Pulmonary and Critical Care Medicine, Chaoyang Hospital, Capital Medical University, Beijing, 100029, P.R. China.,Department of Respiratory Medicine, Capital Medical University, Beijing, 100069, P.R. China
| | - Lei Wang
- Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P.R. China.,Department of Respiratory Medicine, Capital Medical University, Beijing, 100069, P.R. China
| | - Jie Liu
- Department of Physiology and Pathophysiology, Capital Medical University, Beijing, 100069, P.R. China.,Department of Respiratory Medicine, Capital Medical University, Beijing, 100069, P.R. China
| | - Shengfeng Wang
- Institute of Public Health, Peking University, Beijing, 100871, P.R. China
| | - Yuanhua Yang
- Department of Pulmonary and Critical Care Medicine, Chaoyang Hospital, Capital Medical University, Beijing, 100029, P.R. China.,Department of Respiratory Medicine, Capital Medical University, Beijing, 100069, P.R. China
| | - Ting Yang
- Department of Respiratory Medicine, Capital Medical University, Beijing, 100069, P.R. China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, P.R. China
| | - Chen Wang
- Department of Respiratory Medicine, Capital Medical University, Beijing, 100069, P.R. China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, P.R. China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, P.R. China
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20
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Vespasiani-Gentilucci U, Pedone C, Muley-Vilamu M, Antonelli-Incalzi R. The pharmacological treatment of chronic comorbidities in COPD: mind the gap! Pulm Pharmacol Ther 2018; 51:48-58. [PMID: 29966745 DOI: 10.1016/j.pupt.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is commonly associated with other chronic diseases, which poses several diagnostic and therapeutic problems. Indeed, important comorbidities frequently remain unrecognized and, then, untreated, whereas respiratory drugs may have non respiratory side effects, and selected non respiratory drugs may variably affect the respiratory function. OBJECTIVE to describe: how COPD affects the presentation and contributes to the diagnostic challenges of its most common comorbidities; how coexisting COPD impacts the therapeutic approach to selected comorbidities and viceversa. METHODS we distinguish comorbidities of COPD depending upon whether they are complications of COPD or share risk factors, mainly smoke, with it or, finally, aggravate COPD. We describe atypical presentations of and diagnostic clues to comorbidities and suggest screening procedures. Finally, the main therapeutic problems, as resulting from the risk of untoward effects of therapies of COPD and its comorbidity, with special attention to drug-drug interactions and possible overdosages, are described. RESULTS selected complications of COPD, such as osteoporosis, sarcopenia and dysphagia, are rarely recognized and treated, likely due to the poor awareness of them. Important comorbidities, such as coronary artery disease, chronic heart failure, obstructive sleep apnoea syndrome and chronic renal failure, also should be systematically searched for because of their commonly variant presentation. Disease-related symptoms should be distinguished from drug effects or drug-drug interaction effects. CONCLUSIONS a truly comprehensive view of the complex COPD patient, hopefully capitalizing on multidimensional geriatric assessment, is needed to dissect the many components of health status impairment and to provide the optimal care. Selected screening procedures are highly desirable to identify frequently missed comorbidities. Pharmacosurveillance is an essential part of the approach to COPD and its comorbidities.
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Affiliation(s)
| | - Claudio Pedone
- Internal Medicine and Geriatrics Area, University Campus Bio-Medico of Rome, Italy
| | - Moises Muley-Vilamu
- Internal Medicine and Geriatrics Area, University Campus Bio-Medico of Rome, Italy
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21
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Pourmand A, Robinson H, Mazer-Amirshahi M, Pines JM. Pulmonary Embolism Among Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: Implications For Emergency Medicine. J Emerg Med 2018; 55:339-346. [PMID: 29945817 DOI: 10.1016/j.jemermed.2018.05.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/01/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Common in COPD are acute exacerbations (AE-COPD) that cause acute dyspnea, cough, and bronchospasm. Symptoms of AE-COPD mimic pulmonary embolism (PE). METHODS We conducted a systematic review of the literature to assess the prevalence of PE in patients admitted to the hospital with a clinical diagnosis of AE-COPD. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we queried PubMed and MEDLINE databases from 1990 to 2017. The search term "prevalence pulmonary embolism, COPD" was used, and Boolean operators were used to combine search terms. Data were extracted from each article, specifically the sample size, study setting, design, and the prevalence of PE. RESULTS A total of 5 articles were included that demonstrated a prevalence of PE among patients with a clinical diagnosis of AE-COPD that ranged from 3.3-29.1%. Sample sizes varied from 49-197 patients. Studies occurred in both emergency department and inpatient settings, including intensive care units. Among the studies that reported patient characteristics associated with PE in AE-COPD, both obesity and immobility were important. CONCLUSION Studies reporting the prevalence of PE during AE-COPD vary considerably in their methods and results. Because of the relatively high prevalence of PE during AE-COPD, it is important for providers to be aware of this linkage between the 2 conditions and to screen patients using clinical gestalt and validated screening tools until more emergency department data are available.
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Affiliation(s)
- Ali Pourmand
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Hannah Robinson
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, District of Columbia
| | - Jesse M Pines
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
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22
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Kubota Y, London SJ, Cushman M, Chamberlain AM, Rosamond WD, Heckbert SR, Zakai N, Folsom AR. Lung function, respiratory symptoms and venous thromboembolism risk: the Atherosclerosis Risk in Communities Study. J Thromb Haemost 2016; 14:2394-2401. [PMID: 27696765 PMCID: PMC5378065 DOI: 10.1111/jth.13525] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Indexed: 02/02/2023]
Abstract
Essentials The association of lung function with venous thromboembolism (VTE) is unclear. Chronic obstructive pulmonary disease (COPD) patterns were associated with a higher risk of VTE. Symptoms were also associated with a higher risk of VTE, but a restrictive pattern was not. COPD may increase the risk of VTE and respiratory symptoms may be a novel risk marker for VTE. SUMMARY Background The evidence for the association between chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VTE) is limited. There is no study investigating the association between restrictive lung disease (RLD) and respiratory symptoms with VTE. Objectives To investigate prospectively the association of lung function and respiratory symptoms with VTE. Patients/Methods In 1987-1989, we assessed lung function by using spirometry, and obtained information on respiratory symptoms (cough, phlegm, and dyspnea) in 14 654 participants aged 45-64 years, without a history of VTE or anticoagulant use, and followed them through 2011. Participants were classified into four mutually exclusive groups: 'COPD' (forced expiratory volume in 1 s [FEV1 ]/forced vital capacity [FVC] below the lower limit of normal [LLN]), 'RLD' (FEV1 /FVC ≥ LLN and FVC < LLN), 'respiratory symptoms with normal spirometic results' (without RLD or COPD), and 'normal' (without respiratory symptoms, RLD, or COPD). Results We documented 639 VTEs (238 unprovoked and 401 provoked VTEs). After adjustment for VTE risk factors, VTE risk was increased for individuals with either respiratory symptoms with normal spirometric results (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.12-1.73) or COPD (HR 1.33, 95% CI 1.07-1.67) but not for those with RLD (HR 1.15, 95% CI 0.82-1.60). These elevated risks of VTE were derived from both unprovoked and provoked VTE. Moreover, FEV1 and FEV1 /FVC showed dose-response relationships with VTE. COPD was more strongly associated with pulmonary embolism than with deep vein thrombosis. Conclusions Obstructive spirometric patterns were associated with an increased risk of VTE, suggesting that COPD may increase the risk of VTE. Respiratory symptoms may represent a novel risk marker for VTE.
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Affiliation(s)
- Yasuhiko Kubota
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Stephanie J. London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont College of Medicine, Burlington, VT, USA
| | | | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Neil Zakai
- Departments of Medicine and Pathology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Abstract
Thrombosis is a complication of many chronic illnesses. Chronic obstructive pulmonary disease (COPD) and diabetes mellitus are common medical conditions frequently associated with a hypercoagulable state. Acidaemia has been shown to reduce coagulation. COPD and diabetes mellitus during acute deterioration can present with a severe acidaemia. The impact of this acidaemia on coagulation is poorly studied. Patients presenting with a diagnosis of diabetic ketoacidosis or type II respiratory failure from COPD and a pH of less than 7.2 were included in our study. A coagulation screen and a thromboelastograph (TEG) were performed on admission and 24 hours later. The mean pH on admission was 7.07 and mean base excess was -16.3. The activated partial thromboplastin time was associated with pH change but remained within the normal range (26-41 s). All other coagulation and TEG parameters failed to show evidence of association (p>0.05). In the two models of non-haemorrhagic acidosis investigated, coagulation was not altered by the changes in pH. More work is needed to understand the complex relationship between factors affecting coagulation in individual disease processes.
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Affiliation(s)
- Hayden White
- Griffiths University, Department of Intensive Care, Logan Hospital, Meadowbrook, Australia
| | - Robert Bird
- Princess Alexandra Hospital, Woolloongabba, Australia
| | | | - Mark Jones
- University of Queensland, School of Population Health, Herston, Australia
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24
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Børvik T, Brækkan SK, Enga K, Schirmer H, Brodin EE, Melbye H, Hansen JB. COPD and risk of venous thromboembolism and mortality in a general population. Eur Respir J 2015; 47:473-81. [PMID: 26585434 DOI: 10.1183/13993003.00402-2015] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/23/2015] [Indexed: 01/01/2023]
Abstract
The relationship between chronic obstructive pulmonary disease (COPD) and risk of venous thromboembolism (VTE) has been scarcely studied in the general population. We aimed to investigate the association between COPD and risk of VTE and mortality in a population-based cohort.Spirometry was conducted in 8646 males and females, participating in the fifth (2001-02) and sixth (2007-08) surveys of the Tromsø Study. Incident VTE events during follow-up were registered from the date of inclusion to December 31, 2011. Cox-regression models with COPD stages and confounders as time varying covariates were used to calculate hazard ratios with 95% confidence intervals for VTE and all-cause mortality.During a median follow-up of 6.2 years, 215 subjects developed VTE. Subjects with COPD stage III/IV had a two-fold higher risk of secondary VTE compared to subjects with normal airflow (HR 2.05, 95% CI 1.02-4.10). COPD patients, particularly those with stage III/IV disease, with VTE had a higher mortality rate than COPD patients without VTE (50.2% versus 5.6% per year).Our findings suggest that patients with severe COPD may have increased risk of secondary VTE, and that COPD patients with VTE have a higher mortality rate than COPD patients without VTE.
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Affiliation(s)
- Trond Børvik
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Kristin Enga
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ellen E Brodin
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Hasse Melbye
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - John-Bjarne Hansen
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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25
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Abstract
Most studies have focused on the prevalence of deep vein thrombosis (DVT) and pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acute exacerbation in Caucasian populations. DVT is supposedly less likely to occur among Asians than Caucasians, and the primary purpose of this study was to determine the actual incidence of DVT in patients with COPD in Asian populations.We enrolled patients over the age of 40 with a diagnosis of COPD (International Classification of Diseases, Ninth Revision [ICD-9]: 490-492, 496; A-code: A323 and A325) between 1998 and 2008. The index date was the date of first-time COPD diagnosis. We excluded the patients who had been diagnosed with COPD and DVT (The International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]: 453.8) before index date. The control group was frequency-matched according to age (3-year stratum), sex, and the year of admission, at a 2:1 ratio. Patients were followed from index date to when either a diagnosis of DVT was made, death occurred, December 31, 2009 was reached, or when the patients withdrew from the National Health Insurance program.The overall incidence rate of DVT was 18.78 per 10,000 person-years in patients with COPD, and the adjusted hazard ration of DVT in patients with COPD was 1.38 (95% confidence interval 1.06-1.80), which was greater than patients without COPD after adjusting for age, sex, atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accident, congestive heart failure, lower leg fracture or surgery, and cancer.Asian patients with COPD had a higher incidence of DVT than non-COPD patients.
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Affiliation(s)
- Chung-Yu Chen
- From the School of Pharmacy, Kaohsiung Medical University and Department of Pharmacy, Kaohsiung Medical University Hospital (C-YC); and Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan (K-ML)
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Keller K, Prochaska JH, Coldewey M, Gobel S, Ullmann A, Jünger C, Lamparter H, Ariza L, Bickel C, Lauterbach M, Konstantinides S, Rostock T, Münzel T, Wild PS. History of deep vein thrombosis is a discriminator for concomitant atrial fibrillation in pulmonary embolism. Thromb Res 2015; 136:899-906. [PMID: 26376038 DOI: 10.1016/j.thromres.2015.08.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/22/2015] [Accepted: 08/29/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is the consequence of deep vein thrombosis (DVT) in 70% of all cases. Although, PE and DVT are commonly related to risk factors of Virchow's triad, both entities are linked to cardiovascular risk factors, but risk factors seem differently important in both entities. OBJECTIVES We aimed to investigate clinical profile and outcome of patients with PE history stratified by concomitant DVT. PATIENTS/METHODS Data from the observational multi-center thrombEVAL-study were analyzed. RESULTS The sample (N=2,318) comprised 295 PE patients, of whom 69.2% (N=204) had DVT. Individuals without DVT were older and had higher prevalence of concomitant atrial fibrillation (AF), chronic lung diseases, coronary artery disease, heart failure and hypertension. Multivariable regression revealed an independent association of AF (Odds Ratio (OR) 3.17, 95% CI 1.63-6.18, P<0.001) and coronary artery disease (OR 2.31, 95% CI 1.15-4.66, P=0.019) with PE without DVT. There was higher frequency of permanent AF in individuals without DVT, whereas paroxysmal AF was more prevalent in individuals with DVT. All AF subtypes were independently associated with PE without DVT with increasing ORs from paroxysmal to permanent AF. PE patients with and without DVT did not differ in survival (P=0.32) and cost-relevant clinical outcome (P=0.26) during follow-up. AF in PE patients was associated with cost-relevant clinical outcome (Hazard Ratio (HR) 1.78, 95% CI 1.03-3.09, P=0.040), but no significant difference in survival (HR 0.93, 95% CI 0.35-2.50, P=0.88) was observed. CONCLUSIONS History of DVT is a significant discriminator for clinical profile of PE patients. Individuals without DVT had more often cardiac and pulmonary disease with strongest association with AF. Data advocate a potential link between AF and PE. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov, Unique identifier NCT01809015.
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Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Meike Coldewey
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Gobel
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany
| | - Alexander Ullmann
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany
| | - Claus Jünger
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany
| | - Heidrun Lamparter
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany
| | - Liana Ariza
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany
| | - Christoph Bickel
- Department of Medicine I, Federal Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Michael Lauterbach
- Department of Internal Medicine III, Hospital of Barmherzige Brüder Trier, Trier, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Rostock
- Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany; Preventive Cardiology and Preventive Medicine, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany.
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27
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Tsang JYC, Hogg JC. Gas exchange and pulmonary hypertension following acute pulmonary thromboembolism: has the emperor got some new clothes yet? Pulm Circ 2014; 4:220-36. [PMID: 25006441 DOI: 10.1086/675985] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/17/2014] [Indexed: 01/09/2023] Open
Abstract
Patients present with a wide range of hypoxemia after acute pulmonary thromboembolism (APTE). Recent studies using fluorescent microspheres demonstrated that the scattering of regional blood flows after APTE, created by the embolic obstruction unique in each patient, significantly worsened regional ventilation/perfusion (V/Q) heterogeneity and explained the variability in gas exchange. Furthermore, earlier investigators suggested the roles of released vasoactive mediators in affecting pulmonary hypertension after APTE, but their quantification remained challenging. The latest study reported that mechanical obstruction by clots accounted for most of the increase in pulmonary vascular resistance, but that endothelin-mediated vasoconstriction also persisted at significant level during the early phase.
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Affiliation(s)
- John Y C Tsang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - James C Hogg
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
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Kim V, Goel N, Gangar J, Zhao H, Ciccolella DE, Silverman EK, Crapo JD, Criner GJ. Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2014; 1:239-249. [PMID: 25844397 DOI: 10.15326/jcopdf.1.2.2014.0133#sthash.pvwpnxai.dpuf] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND COPD patients are at increased risk for venous thromboembolism (VTE). VTE however remains under-diagnosed in this population and the clinical profile of VTE in COPD is unclear. METHODS Global initiative for chronic Obstructive Lung Disease (GOLD) stages II-IV participants in the COPD Genetic Epidemiology (COPDGene) study were divided into 2 groups: VTE+, those who reported a history of VTE by questionnaire, and VTE-, those who did not. We compared variables in these 2 groups with either t-test or chi-squared test for continuous and categorical variables, respectively. We performed a univariate logistic regression for VTE, and then a multivariate logistic regression using the significant predictors of interest in the univariate analysis to ascertain the determinants of VTE. RESULTS The VTE+ group was older, more likely to be Caucasian, had a higher body mass index (BMI), smoking history, used oxygen, had a lower 6-minute walk distance, worse quality of life scores, and more dyspnea and respiratory exacerbations than the VTE- group. Lung function was not different between groups. A greater percentage of the VTE+ group described multiple medical comorbidities. On multivariate analysis, BMI, 6-minute walk distance, pneumothorax, peripheral vascular disease, and congestive heart failure significantly increased the odds for VTE by history. CONCLUSIONS BMI, exercise capacity, and medical comorbidities were significantly associated with VTE in moderate to severe COPD. Clinicians should suspect VTE in patients who present with dyspnea and should consider possibilities other than infection as causes of COPD exacerbation.
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Affiliation(s)
- Victor Kim
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Nishant Goel
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jinal Gangar
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - David E Ciccolella
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, University of Colorado, School of Medicine, Denver
| | - Gerard J Criner
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
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Kim V, Goel N, Gangar J, Zhao H, Ciccolella DE, Silverman EK, Crapo JD, Criner GJ. Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2014. [PMID: 25844397 DOI: 10.15326/jcopdf.1.2.2014.0133] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND COPD patients are at increased risk for venous thromboembolism (VTE). VTE however remains under-diagnosed in this population and the clinical profile of VTE in COPD is unclear. METHODS Global initiative for chronic Obstructive Lung Disease (GOLD) stages II-IV participants in the COPD Genetic Epidemiology (COPDGene) study were divided into 2 groups: VTE+, those who reported a history of VTE by questionnaire, and VTE-, those who did not. We compared variables in these 2 groups with either t-test or chi-squared test for continuous and categorical variables, respectively. We performed a univariate logistic regression for VTE, and then a multivariate logistic regression using the significant predictors of interest in the univariate analysis to ascertain the determinants of VTE. RESULTS The VTE+ group was older, more likely to be Caucasian, had a higher body mass index (BMI), smoking history, used oxygen, had a lower 6-minute walk distance, worse quality of life scores, and more dyspnea and respiratory exacerbations than the VTE- group. Lung function was not different between groups. A greater percentage of the VTE+ group described multiple medical comorbidities. On multivariate analysis, BMI, 6-minute walk distance, pneumothorax, peripheral vascular disease, and congestive heart failure significantly increased the odds for VTE by history. CONCLUSIONS BMI, exercise capacity, and medical comorbidities were significantly associated with VTE in moderate to severe COPD. Clinicians should suspect VTE in patients who present with dyspnea and should consider possibilities other than infection as causes of COPD exacerbation.
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Affiliation(s)
- Victor Kim
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Nishant Goel
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jinal Gangar
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - David E Ciccolella
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, University of Colorado, School of Medicine, Denver
| | - Gerard J Criner
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
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Kamel M, Moussa H, Ismail A. Prevalence of venous thrombo-embolism in acute exacerbations of chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis 2013. [DOI: 10.1016/j.ejcdt.2013.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Polosa R, Malerba M, Cacciola RR, Morjaria JB, Maugeri C, Prosperini G, Gullo R, Spicuzza L, Radaeli A, Di Maria GU. Effect of acute exacerbations on circulating endothelial, clotting and fibrinolytic markers in COPD patients. Intern Emerg Med 2013; 8:567-74. [PMID: 21660493 DOI: 10.1007/s11739-011-0636-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are prone to clinical exacerbations that are associated with increased airway inflammation, a potent pro-thrombotic stimulus. Limited information is available on the mechanisms underlying the putative alterations of the endothelial-coagulative system during acute exacerbations. The aim was to investigate whether the activation of the endothelial-coagulative system occurs in association with the acute inflammatory response of COPD exacerbation. We monitored the blood levels of surrogate markers of inflammation: interleukin-6 (IL-6); endothelium damage: von Willebrand's factor (vWF); clotting activation: D-dimer (D-D), and prothrombin fragment 1+2 (F1+2); fibrinolytic response: plasminogen activator inhibitor 1 (PAI-1), in COPD subjects, during hospital admission and after clinical resolution. In 30 COPD subjects, IL-6, vWF, D-D and F1+2 levels were elevated during exacerbation and decreased significantly at clinical stability (IL-6, p = 0.005; vWF, p < 0.001; D-D, p < 0.001; F1+2, p < 0.001). PAI-1 levels did not change at exacerbation compared to clinically stable situations. Positive correlations were observed between several of the markers measured. Elevation of IL-6, vWF, D-D and F1+2 levels during COPD exacerbations implies a strict association between acute inflammation, endothelial activation and clotting initiation. This was not associated with a change in PAI-1, implying an increase in the fibrinolytic response to inflammation. The pro-thrombotic nature of COPD exacerbations sustained by enhanced clotting activation appears to be mitigated by excessive fibrinolysis.
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Affiliation(s)
- Riccardo Polosa
- Dipartimento di Medicina Interna e Specialistica, Università di Catania, Catania, Italy,
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Song YJ, Zhou ZH, Liu YK, Rao SM, Huang YJ. Prothrombotic state in senile patients with acute exacerbations of chronic obstructive pulmonary disease combined with respiratory failure. Exp Ther Med 2013; 5:1184-1188. [PMID: 23596488 PMCID: PMC3627458 DOI: 10.3892/etm.2013.919] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/19/2012] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to study the clinical value of prethrombotic state and treatment with low molecular weight heparin (LMWH) in senile patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure. Hemorheological markers (hematocrit, blood viscosity and plasma viscosity), fibrinogen (FIB), D-dimer and gas analysis were evaluated in 30 senile patients with AECOPD combined with respiratory failure and compared with those in 30 cases without respiratory failure. A total of 30 cases with AECOPD combined with respiratory failure were randomly divided into treatment and control groups. The two groups received conventional treatment. The treatment group also received LMWH injections every 12 h for 6 days and the clinical effect was observed. The levels of FIB, D-dimer, hematocrit, blood viscosity and plasma viscosity were significantly higher in the patients with AECOPD combined with respiratory failure compared with those in the patients without respiratory failure. The plasma D-dimer and FIB levels had significantly positive correlations with the partial pressure of CO2 (PaCO2) and negative correlations with the partial pressure of O2 (PaO2) in the patients with AECOPD combined with respiratory failure. The curative effect was improved in the treatment group, compared with that in the control group without side-effects. However, no significant changes in activated partial thromboplastin time (APTT) and international normalized ratio (INR) were observed between the treatment and control groups. The senile patients with AECOPD combined with respiratory failure suffered from hypercoagulation. Early detection and diagnosis of the prethrombotic state and timely treatment with LMWH may benefit these patients without side-effects.
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Affiliation(s)
- Ya-Jun Song
- Department of Respiratory Medicine, Huangpu District Central Hospital, Shanghai 200002, P.R. China
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Piazza G, Goldhaber SZ, Kroll A, Goldberg RJ, Emery C, Spencer FA. Venous thromboembolism in patients with chronic obstructive pulmonary disease. Am J Med 2012; 125:1010-8. [PMID: 22884176 PMCID: PMC3455107 DOI: 10.1016/j.amjmed.2012.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/13/2012] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Our aim was to compare the clinical characteristics, prophylaxis, treatment, and outcomes of venous thromboembolism in patients with and without previously diagnosed chronic obstructive pulmonary disease. METHODS We analyzed the population-based Worcester Venous Thromboembolism Study of 2488 consecutive patients with validated venous thromboembolism to compare clinical characteristics, prophylaxis, treatment, and outcomes in patients with and without chronic obstructive pulmonary disease. RESULTS Of 2488 patients with venous thromboembolism, 484 (19.5%) had a history of clinical chronic obstructive pulmonary disease and 2004 (80.5%) did not. Patients with chronic obstructive pulmonary disease were older (mean age 68 vs 63 years) and had a higher frequency of heart failure (35.5% vs 12.9%) and immobility (53.5% vs 43.3%) than patients without chronic obstructive pulmonary disease (all P<.0001). Patients with chronic obstructive pulmonary disease were more likely to die in hospital (6.8% vs 4%, P=.01) and within 30 days of venous thromboembolism diagnosis (12.6% vs 6.5%, P<.0001). Patients with chronic obstructive pulmonary disease demonstrated increased mortality despite a higher frequency of venous thromboembolism prophylaxis. Immobility doubled the risk of in-hospital death (adjusted odds ratio, 2.21; 95% confidence interval, 1.35-3.62) and death within 30 days of venous thromboembolism diagnosis (adjusted odds ratio, 2.04; 95% confidence interval, 1.43-2.91). CONCLUSION Patients with chronic obstructive pulmonary disease have an increased risk of dying during hospitalization and within 30 days of venous thromboembolism diagnosis. Immobility in patients with chronic obstructive pulmonary disease is an ominous risk factor for adverse outcomes.
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Affiliation(s)
- Gregory Piazza
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Aw A, Carrier M, Koczerginski J, McDiarmid S, Tay J. Incidence and predictive factors of symptomatic thrombosis related to peripherally inserted central catheters in chemotherapy patients. Thromb Res 2012; 130:323-6. [DOI: 10.1016/j.thromres.2012.02.048] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/22/2012] [Accepted: 02/28/2012] [Indexed: 12/11/2022]
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Sharif-Kashani B, Shahabi P, Raeissi S, Behzadnia N, Shoaraka A, Shahrivari M, Saliminejad L, Pozhhan S, Hashemian MR, Masjedi MR, Bikdeli B. AssessMent of ProphylAxis for VenouS ThromboembolIsm in Hospitalized Patients. Clin Appl Thromb Hemost 2012; 18:462-8. [DOI: 10.1177/1076029611431955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Venous thromboembolism (VTE) accounts for several cases of in-hospital mortality (over 100 000 deaths annually in the West). Despite the existence of effective prophylaxis guidelines for at-risk patients, the guidelines adherence is missing. Methods: We evaluated the thromboprophylaxis reception and appropriateness based on the eighth edition of the American College of Chest Physicians (ACCP) guidelines on VTE prophylaxis, among hospitalized patients of a World Health Organization (WHO)-collaborating teaching hospital in a 3-month period. Results: From the 904 evaluated cases, 481 entered the study. Appropriate decision on whether to prophylaxe or not, was made in 305 (63.40%), however, complete appropriateness (considering correct regimen type, dosing, and duration) was seen only in 229 patients (47.60%). The ACCP risk for VTE was the strongest predictor of thromboprophylaxis prescription (odds ratio [OR]: 2.62, 95% confidence interval [CI]: 1.35-5.05). Conclusions: Our thromboprophylaxis results were comparable to that of Western countries. Improved thromboprophylaxis appropriateness, which requires improving the physicians' thromboprophylaxis awareness and knowledge, could reduce the rate of in-hospital VTE and translate into better patient care.
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Affiliation(s)
- Babak Sharif-Kashani
- Tobacco Prevention and Control Research Center
- Lung Transplantation Research Center
| | | | | | | | | | | | | | | | | | - Mohammad-Reza Masjedi
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih-Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran
| | - Behnood Bikdeli
- Tobacco Prevention and Control Research Center
- Cardiovascular Research Center, Shahid Beheshti University MC, Tehran, Iran
- Center for Outcomes Research and Evaluation
- Section of Cardiovascular Medicine, Department of Internal medicine, Yale University School of Medicine, New Haven, CT, USA
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Aissa I, Rachdi I, Ben Miled K, Ghedira H. [Incidence of venous thromboembolism in men admitted to a pneumology unit for acute respiratory disease]. Rev Pneumol Clin 2011; 67:129-135. [PMID: 21665075 DOI: 10.1016/j.pneumo.2010.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 02/15/2010] [Accepted: 04/27/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major source of morbidity and mortality all over the world. It is one of the complications arising in a hospital environment. The main aim of this study is to estimate the incidence of VTE in respiratory inpatients. METHOD The authors carried out a prospective study on acute respiratory disease inpatients. A medical analytical index card was used. An echo-venous Doppler of lower limbs was practiced on D1 and D10 of hospitalization. The Wells scored was used to estimate the clinical probability of the occurrence of VTE. RESULTS Seven of 100 patients studied developed VTE (95% CI : 2-12%), four of which presented a pulmonary embolism. The patients with VTE are 60-years-old±11.67. The incidence of VTE includes 20% (95% CI : 12.2-27.8%) of the patients hospitalized for bronchial cancer, 7.14% (95% CI : 2.1-12.18) of the patients presenting pulmonary tuberculosis and 4.54% (95% CI : 0.46-8.62%) of the patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). The duration of hospitalization was prolonged for the treatment of VTE (21±4.41 days for these patients compared with 12±5 days in the absence of VTE (P<0.001)). The analysis of the various risk factors shows that a Performance Status>2 (P=0.005) and lung cancer (P=0.028) are the factors most incriminated in the occurrence of VTE. It is associated with a mortality of 2%. CONCLUSION VTE is a reality which is necessary to prevent in respiratory inpatients in situations at risk, especially in patients with lung cancer and with a PS>2.
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Affiliation(s)
- I Aissa
- Service de pneumologie I, Pavillon I, hôpital Abderrahman Mami, Ariana, Tunisie. imen
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Roversi P, Campanini M. BPCO e tromboembolismo venoso. Italian Journal of Medicine 2011. [DOI: 10.1016/j.itjm.2011.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sabit R, Thomas P, Shale DJ, Collins P, Linnane SJ. The Effects of Hypoxia on Markers of Coagulation and Systemic Inflammation in Patients With COPD. Chest 2010; 138:47-51. [DOI: 10.1378/chest.09-2764] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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40
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Hall IE, Andersen MS, Krumholz HM, Gross CP. Predictors of venous thromboembolism in patients with advanced common solid cancers. J Cancer Epidemiol 2009; 2009:182521. [PMID: 20445797 DOI: 10.1155/2009/182521] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 10/23/2009] [Accepted: 12/09/2009] [Indexed: 12/21/2022] Open
Abstract
There is uncertainty about risk heterogeneity for venous thromboembolism (VTE) in older patients with advanced cancer and whether patients can be stratified according to VTE risk. We performed a retrospective cohort study of the linked Medicare-Surveillance, Epidemiology, and End Results cancer registry in older patients with advanced cancer of lung, breast, colon, prostate, or pancreas diagnosed between 1995-1999. We used survival analysis with demographics, comorbidities, and tumor characteristics/treatment as independent variables. Outcome was VTE diagnosed at least one month after cancer diagnosis. VTE rate was highest in the first year (3.4%). Compared to prostate cancer (1.4 VTEs/100 person-years), there was marked variability in VTE risk (hazard ratio (HR) for male-colon cancer 3.73 (95% CI 2.1-6.62), female-colon cancer HR 6.6 (3.83-11.38), up to female-pancreas cancer HR 21.57 (12.21-38.09). Stage IV cancer and chemotherapy resulted in higher risk (HRs 1.75 (1.44-2.12) and 1.31 (1.0-1.57), resp.). Stratifying the cohort by cancer type and stage using recursive partitioning analysis yielded five groups of VTE rates (nonlocalized prostate cancer 1.4 VTEs/100 person-years, to nonlocalized pancreatic cancer 17.4 VTEs/100 patient-years). In a high-risk population with advanced cancer, substantial variability in VTE risk exists, with notable differences according to cancer type and stage.
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Fimognari FL, Loffredo L, Di Simone S, Sampietro F, Pastorelli R, Monaldo M, Violi F, D'Angelo A. Hyperhomocysteinaemia and poor vitamin B status in chronic obstructive pulmonary disease. Nutr Metab Cardiovasc Dis 2009; 19:654-659. [PMID: 19282159 DOI: 10.1016/j.numecd.2008.12.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 10/31/2008] [Accepted: 12/05/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Patients with chronic obstructive pulmonary disease (COPD) are at increased atherothrombotic risk. Preliminary findings have suggested that COPD patients may have increased plasma total homocysteine (tHcy), a cardiovascular risk factor often caused by a poor B vitamin status, but plasma levels of such vitamins were not measured. The aim of this study was to investigate hyperhomocysteinaemia in COPD and to determine whether it may be secondary to poor plasma concentrations of B vitamins. METHODS AND RESULTS We performed a case-control, cross-sectional study of 42 patients with COPD and 29 control subjects. Folate, vitamin B12, vitamin B6, tHcy, renal function, C-reactive protein, blood gases and lipids were measured in patients and controls. COPD patients had higher plasma tHcy (median: 13.9mumol/l, interquantile range [IQR]: 12.1-18.5 versus 11.5, IQR: 10.1-14, p=0.002) and lower circulating folate (median: 2.5ng/ml, IQR: 1.2-3.3 versus 2.8, IQR: 2.1-4 of controls, p=0.03) than controls had. Compared to the control group, COPD was associated with higher tHcy concentrations also after adjusting for smoking, heart failure, renal function and C-reactive protein with logistic regression analysis (OR 1.36, 95% CI 1.06-1.72, p=0.01). In the COPD group, low levels of folate (beta=-0.27, p=0.02) and vitamin B12 (beta=-0.24, p=0.04), and hypertriglyceridaemia (beta=0.580, p<0.0001) were independent predictors of the presence of high tHcy concentrations in a multiple linear regression model (adjusted R(2)=0.522). CONCLUSION COPD patients have a poor B vitamin status and, as a consequence, increased tHcy. These abnormalities may contribute to the COPD-related atherothrombotic risk.
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Affiliation(s)
- F L Fimognari
- Unit of Respiratory Diseases, Division of Internal Medicine, Leopoldo Parodi Delfino Hospital, ASL Roma G, Colleferro (Rome), Italy.
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Abstract
A standardized definition of chronic obstructive pulmonary disease (COPD) exacerbation still represents an unmet need in respiratory medicine; definitions currently rely on clinical empiricism with little evidence-based scientific support. Exacerbations of COPD are certainly clear events in the mind of practicing physicians. However, when one tries to provide simple concepts such as their definition and classification of severity, one realizes how little we know. Current symptom- and event-based definitions of a COPD exacerbation, as well as the classifications of the severity of COPD exacerbations, all have their own limitations. Efforts to assess the efficacy of new therapies in the treatment and prevention of COPD exacerbations have been hampered by the lack of a widely agreed upon and consistently used definition. There is a need for greater investment in research on COPD exacerbations in order to promote a better understanding of COPD exacerbations.
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Zvezdin B, Milutinov S, Kojicic M, Hadnadjev M, Hromis S, Markovic M, Gajic O. A postmortem analysis of major causes of early death in patients hospitalized with COPD exacerbation. Chest 2009; 136:376-380. [PMID: 19318666 DOI: 10.1378/chest.08-2918] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mortality from COPD is increasing worldwide, but detailed causes of death are rarely assessed, particularly in low-income countries. METHODS In a retrospective study, we reviewed the autopsy reports and medical records of deceased patients admitted to the hospital for severe exacerbation of COPD, from January 2005 to December 2007, at the Institute for Pulmonary Diseases of Vojvodina, Serbia. RESULTS Forty-three patients with a hospital admission diagnosis of COPD exacerbation underwent autopsy; all had died within 24 h of admission to the hospital. Twenty-three patients (54%) had a long COPD history (> 10 years), and 19 patients (44%) had more than one hospitalization in the last year of life. The median age at death was 70 years (interquartile range, 65 to 75 years), and male sex was predominant (n = 31; 72%). The main (primary) causes of death were reported as cardiac failure (n = 16; 37.2%), pneumonia (n = 12; 27.9%), and pulmonary thromboembolism (PTE) (n = 9; 20.9%). Respiratory failure due to a progression of COPD was the primary cause of death in six patients (14%). Most patients had more then one comorbid disease (n = 33; 77%), and the most frequent comorbid disease was chronic heart failure (n = 25; 58%). CONCLUSIONS Autopsy results suggest that common contributing causes of early death in patients hospitalized with severe COPD exacerbation are concomitant complications, as follows: cardiac failure, pneumonia, and PTE. Quality improvement interventions should focus on recognizing and treating these conditions at the time of hospital admission.
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Affiliation(s)
- Biljana Zvezdin
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
| | - Senka Milutinov
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Marija Kojicic
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Mirjana Hadnadjev
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Sanja Hromis
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Marica Markovic
- Nijmegen Center of Molecular Life Science, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Abstract
Exacerbations of COPD have a profound detrimental effect on the patient and impose a significant burden on healthcare resource utilization. Prevention and treatment of exacerbations are major objectives of the clinical management of COPD. For this approach to be successful, clinicians must combine both pharmacologic approaches and non-pharmacologic strategies aimed at improving the patient's disease management. Non-pharmacologic approaches include those that can be incorporated into the office setting as well as intervention strategies that are integrated into the lifelong management of COPD. These strategies include developing a partnership with the patient and their social supports, encouraging and facilitating smoking cessation, immunizations, proper use of supplemental oxygen, and most importantly, giving the patient the tools to manage their illness appropriately. Moreover there is clear evidence of an irrevocable decline in pulmonary function after each exacerbation, usually resulting in reduced physical activity and impaired skeletal muscle function. Not surprisingly, pulmonary rehabilitation after such events has been shown to prevent relapse, improve survival and enhance patients' overall function after acute exacerbations.
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Affiliation(s)
- Marc Decramer
- Respiratory Division, University Hospitals Leuven, and Katholieke Universiteit Leuven, Leuven, Belgium
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Alikhan R, Spyropoulos AC. Epidemiology of venous thromboembolism in cardiorespiratory and infectious disease. Am J Med 2008; 121:935-42. [PMID: 18954836 DOI: 10.1016/j.amjmed.2008.05.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 05/16/2008] [Accepted: 05/20/2008] [Indexed: 11/21/2022]
Abstract
Venous thromboembolic complications -- deep vein thrombosis and pulmonary embolism -- occur in a significant proportion of hospitalized medical patients. The incidence in acutely ill medical patients is 10%-40%, equivalent to that seen in general surgical patients. Prophylaxis is effective and well tolerated, yet remains under-prescribed in medical wards. Current recommendations for prophylaxis are generalized and do not specifically address many patient groups. Data on the prevalence in patients with chronic obstructive pulmonary disease, heart failure, and infectious diseases are limited. However, studies on large numbers of hospitalized patients with these admission diagnoses have provided important information on incidence, and the efficacy of thromboprophylaxis. This review summarizes current knowledge of the epidemiology of venous thromboembolism in patients with chronic obstructive pulmonary disease, heart failure, and infectious diseases, and highlights the benefits of, and needs for, appropriate prophylaxis in these groups. Increased awareness of the prevalence of thrombosis in the major subgroups of medical inpatients should improve the prescribing of prophylaxis and prevent potentially avoidable and costly complications.
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Abstract
Dyspnea in patients with known chronic obstructive pulmonary disease (COPD) can be a clinical challenge due to the nonspecific nature of atypical presentations. Typical features of fever, productive cough, and wheezing on presentation support COPD exacerbation, while absence of such findings may warrant further evaluation for underlying etiologies, including pulmonary embolism (PE). It is suspected that one in four patients with atypical COPD exacerbation may have PE as an underlying or concomitant cause of acute dyspnea. This review discusses the clinical presentation of COPD and PE, and presents an overview of the rationale for pursuing work-up for thromboembolic disease in the setting of known obstructive lung diseases.
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Affiliation(s)
- Teng Moua
- Department of Internal Medicine, University of Wisconsin Hospitals and Clinics, Madison,WI 53792-9988, USA
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Shetty R, Seddighzadeh A, Piazza G, Goldhaber SZ. Chronic obstructive pulmonary disease and deep vein thrombosis: a prevalent combination. J Thromb Thrombolysis 2008; 26:35-40. [DOI: 10.1007/s11239-007-0157-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 10/01/2007] [Indexed: 10/22/2022]
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Akgun M, Meral M, Onbas O, Araz O, Koplay M, Aslan S, Mirici A. Comparison of clinical characteristics and outcomes of patients with COPD exacerbation with or without venous thromboembolism. Respiration 2006; 73:428-33. [PMID: 16636527 DOI: 10.1159/000092952] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 02/20/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although some studies evaluated venous thromboembolism (VTE) prevalence in patients with chronic obstructive pulmonary disease (COPD), they contain no detailed description of the patients' characteristics. OBJECTIVES It was the aim of this study to investigate the frequency and clinical characteristics and outcomes of VTE in patients with COPD exacerbation. METHODS Between October 2004 and February 2005, 120 consecutive patients were included in the study. On admission, Doppler examination of lower extremities in all cases and spiral computed tomography of the thorax in cases with a suspicion of pulmonary thromboembolism were performed. A questionnaire was used to take a detailed history. In addition to routine laboratory tests, chest X-ray, postbronchodilator spirometry, arterial blood gas analysis and serum levels of D-dimer and C-reactive protein were evaluated, as well as dyspnea score and performance status before exacerbation. The hospitalization durations and mechanical ventilation requirements were also recorded. RESULTS VTE was determined in 16 cases (13.3%). In patients with VTE, the travel history was higher (p < 0.001), the dyspnea score worse (p = 0.005), the duration of hospitalization longer (p < 0.001) and the mechanical ventilation requirement increased (p < 0.001); a change in mental status was highly associated with the presence of VTE (p < 0.001). CONCLUSIONS It seems that VTE occurrence was higher in the presence of a risk factor causing immobility such as travel history and increased dyspnea. The cases with severe disease are more likely to have VTE. Preventive measures may be considered in such patients because their hospitalization stay and mechanical ventilation requirement are increased.
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Affiliation(s)
- Metin Akgun
- Department of Chest Disease, School of Medicine, Ataturk University, Erzurum, Turkey.
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Erdogmus B, Yazici B, Balbay O, Annakkaya AN, Ozdere BA, Bulut I. Association between varicocele and chronic obstructive pulmonary disease. J Clin Ultrasound 2006; 34:55-9. [PMID: 16547981 DOI: 10.1002/jcu.20195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE To evaluate the relationship between varicocele and chronic obstructive pulmonary disease (COPD) via color duplex sonography. MATERIALS AND METHODS Forty-four male patients with COPD (age range, 50-89 years; mean +/- SD, 66 +/- 9) and 44 male healthy controls (age range, 47-75 years; mean +/- SD, 65 +/- 6) were evaluated with color duplex sonography for unilateral or bilateral varicocele. RESULTS The incidence of right, left, and bilateral varicocele was 47.7%, 65.9%, and 38.6% respectively, in the COPD group, versus 22.7%, 52.3%, and 13.6% in the control group. The incidence of right and bilateral varicocele in the COPD group was significantly higher than in the control group (p < 0.05). The incidence of varicocele also increased with increase in COPD severity. CONCLUSIONS The incidence of varicocele in COPD patients is high. Varicocele might be one of the most important causes of scrotal pain and infertility in COPD patients.
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Affiliation(s)
- Besir Erdogmus
- Department of Radiology, Abant Izzet Baysal University, Duzce Medical School, Kenuralp 81620, Duzce, Turkey
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